Psoratic arthritis and working in healthcare

liz101

Hi,

I recently been diagosed with psoratic arthritis by my rheumatologist (as in 3 days ago). I'm 30years old and I have had psoriasis for 20years, though it is mild and doesn't bother me in any way. I work as a junior doctor in paediatrics, which is pretty high powered and intense at times.

I developed a swollen right thumb joint 3 months ago and a swollen toe (which doesnt bother me) and since I have a bit of background knowledge got referred to rheum quite quickly. My bloods have all been normal, including infammatory markers.
Despite this I was really shocked when the consultant told me that it was PsA and that she recommened me starting methotrexate and enrolling on a trial with a biologic as well as soon as possible.

To me the thought of being on these high power drugs is a big deal, I am around sick children everyday and I am not sure if the treatment that is being recommened is worse than the acutal thumb swelling, which only gives me mild pain and causes discomfort when I write some days.

Does anyone else know of other people taking DMARDS or Biologics that work in healthcare and how they cope, for example with the increased risk of infection.

Thanks

[Deleted User]

Dear Liz101 welcome to Arthritis Care Forums.

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Boomer13

Hi;

I don't work in healthcare or anywhere else due to my PsA. I have taken MTX for two years and Enbrel for four months. With all that, I really don't think I succumb to viruses much easier than I did before. Getting very fatigued and not attending to proper nutrition seems to make me more vulnerable than the drugs do. I'm very diligent about handwashing and don't have children so my exposure is limited, I guess. I find the nausea I have from MTX is the most problematic side-effect.

My PsA was very mild for years and I didn't know I had it. I put my complaints down to hard work and a physical life around horses and my outdoorsy career. After simmering along in just a few joints, it hit hard as a full-body arthritis. I would have leapt at the chance to have treatment early on, had I known how bad it could be. I know we are all different but that's my story. Good luck with your decision and I hope your symptoms remain mild.

dibdab

Hi Liz,

I have RA for which I take a cocktail of Methotrexate, sulphasalazine and Plaquinel. I'm not a medic (though I am the mum of a Paediatrics Registrar so maybe understand a little of what you're coping with), but I was an Early Years teacher for 30 years until taking early retirement 3 years ago. I definitely found that the immune suppressant issue was a big deal for me personally because I picked up every infection that was doing the rounds with the little ones, and no matter how diligent my hand washing etc the little ones haven't learned the art of keeping germs to themselves! . So I dropped the methotrexate until I retired, but paid the penalty in joint issues and subsequently lung damage from the repeated chest infections.

Only you can make the drugs decision, but received wisdom is that early dmard treatment reduces subsequent joint damage. Maybe it's worth considering trialling the drugs to see how they affect you, we are all so very different in terms of how we respond and cope.

What ever you decide, I hope the disease doesn't impact too much on the amazing and valuable career that you have chosen, and that the dreadful pressure the current NHS debacle with Junior Doctor Contracts is creating is soon resolved.

Deb x

TrishaW

Hi Liz,
I have undifferentaited spondyloarthropathy which is very like psoriasis arthritis (sero negative)
I was working in the HIV medicine at time of diagnosis as a specialist nurse, including working with children and families and also the risk of TB.
I was started on early intervention therapy shortly after diagnosis with MTX, sulfasalazine and hydroxychloroquine to minimise joint damage (at that stage mainly my fingers were affected)
I saw the Occ Health nurse/ Dr to discuss possible risks and minimise infections.
I tried to wash my hands even more often than usual (and before touching my eyes etc) and also wiped down my desk/mouse etc twice a day with Clinical Wipes (we hot desked)
Obviously I had flu jabs.
I don't think i got more colds etc but when I did get them it took ages for them to go.
I did start getting more UTIs however, and evntually had to stop the drugs because of that and the side effects I had....I felt they were worse than the actual arthritis.
I was started on humira but again the UTIs kicked in despite daily nitrofurantoin.
Twice I went straight from work to A&E as i felt so awful I was sure I had an infection and was given IV antibiotics but my blood cultures didn't grow anything- I think it was probably viral/exhaustion/working in the NHS!
So now i'm not on any therapy and just manage....luckily my flares are often short lived. Compared to many people i'm fairly stable.
I do know of nurses still on all these drugs though who seem to cope ok.
For me the treatment was far worse than the disease (I felt rubbish the whole time) but if i'd had more joints affected or acute pain I'm sure I would have felt differently and continued the drugs.
My arthritis seems to be a slower burn than other people's and we are all different.
I don't know if it was early treatment with those drugs (for 3 years) that means my arthritis was suppressed abit and and hasn't got too much worse now I'm off treatment (have been for 5 years now) or wether mine would have been slow to deteriorate anyway and i just wasted 3 years on treatment (and no alcohol!)
I think the challenge working in a hospital is that people don't realise you are feeling rubbish and keep heaping more work on you.
Occ Health are vital, and also i got support from our Diversity Team who will support disabilities (which arthritis comes under). I got Access to Work help who provided advice re adaptations to my office space eg a new adjustable chair, sideways mouse etc which made a big difference.
I don't know what to advise re taking the hardcore drugs. the literature suggests taking it early may have some effect on long term outcomes (maybe it did for me)
Maybe take it, allow your body to adapt (ideally take a bit of time off when you start them... I felt sick and dizzy on day 2/3)...see how it goes. You can always stop if they're ot helping/making you worse- but you do need to give them a few months at least.
Also keep a symptom diary so you can look back objectively and assess if they're helping (and also if anything triggers a flare)
good luck!
Trisha